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Washington Perspective

Why grassroots advocacy is the key to power in Washington

From the October 1998 ACP-ASIM Observer, copyright 1998 by the American College of Physicians-American Society of Internal Medicine.

By Robert B. Doherty

Who wields the most power in Washington, D.C.?

Although President Clinton's legal woes might cast some doubt on his power, Americans typically think of the president as having the most influence over public policy. Some might tilt the scale more to Congressional leaders, while the more cynical among us are likely to identify "lobbyists" as the real source of power in the nation's Capitol.

But the most powerful person in Washington is not on the payroll of the federal government or private interest groups. Rather, it is you, the individual citizen. And when it comes to health care issues, it is physicians who yield—or have the potential to yield—the most power over public policy.

This may sound like a naive, even preposterous, statement. In an era when the federal government seems unresponsive to the pleas of physicians for more protection against micromanagement by insurers and federal agencies, it is not surprising that doctors often feel powerless to influence national health policy.

But your influence stems from the fact that no major issue is decided in Washington without legislators' paying attention to how much support—or opposition—there is from "voters back home." While politicians don't always vote according to whims of the electorate, elected leaders who tune out their constituents' concerns don't remain in office for very long.

A single phone call from a concerned physician or patient may not necessarily determine a legislator's vote, but the voices of many physicians—and patients—can make the difference on a critical vote. And just as importantly, your silence can lead a member of Congress to vote in a manner that is not in the best interests of your patients.

Recent examples

Earlier this year, for example, it was widely expected that Congress would finally enact national legislation to control marketing of tobacco products to the young. As it turned out, 1998 marked a year of reversal, not progress, in the campaign to enact a rational tobacco control policy.

Knowledgeable observers attribute the failure of tobacco legislation to many factors. One certainly was the decision of the tobacco industry to withdraw from the effort to fashion a bill based on the settlement reached earlier between the industry and state attorneys general. Another was disagreement within the public health community on whether to extend limits on liability to the tobacco industry.

But the biggest reason that Congress failed to enact tobacco control legislation is that lawmakers felt that not enough voters strongly supported the bills. Countless legislators reported that although they heard from opponents of the bills, they heard very little from physicians, patients and others who favored them. In Washington parlance, there "was no constituency" for tobacco control legislation.

The Lethal Drug Abuse Prevention Act of 1998 (H.R. 4006 and S. 2151) is another example where grassroots advocacy will likely be decisive. Although the intent of the bill is to prevent physicians from prescribing narcotics to help patients commit suicide, ACP-ASIM believes that the bill would increase the suffering of dying patients.

The bill enjoys considerable support in Congress, however. Lawmakers have heard from many voters who are morally opposed to physician-assisted suicide and support the bill because they believe it would prohibit the practice. H.R. 4006/S. 2151 won't actually prohibit physician-assisted suicide; rather, the bills would prohibit physicians from prescribing certain controlled narcotics that may hasten death. They will not stop physicians from prescribing medications that don't fall under the control of the Drug Enforcement Administration.

Until recently, lawmakers hadn't heard from the thousands of physicians and patients who are opposed to physician-assisted suicide but object to the bill because it would harm dying patients and their families.

Leveling the playing field

To level the playing field, ACP-ASIM is making it easier for internists to contact members of Congress. We are working to clearly and concisely explain why a particular issue is important to you and your patients, and how you can make a difference. We are providing you with tools to help you get the message out to your elected officials.

Through its grassroots advocacy program, the College is posting regular "Calls to Action" on ACP-ASIM Online (www. acponline.org). Each "Call to Action" includes a concise description of the issue under consideration in Congress; "talking points" that you can incorporate into your own letter, e-mail, or phone call to your representative; and instructions on how to contact your members of Congress.

ACP-ASIM has also created a grassroots hotline that will allow you to call members of Congress at no cost or obtain the latest information by phone or fax on developments concerning the College's top legislative priorities. (Call 888-218-7770 and provide your membership identification number.) The hotline will also enable us to track how many calls are being placed to each legislator, allowing us to determine how well we are doing in getting the word out.

On particularly urgent votes, ACP-ASIM will periodically send out a special mailing to all members in a particular state or district. Prior to a vote in the Senate Judiciary Committee on the Lethal Drug Abuse Prevention Act, for example, the College sent out a letter from ACP-ASIM President Harold C. Sox, FACP, to 11,000 members in key states that have a senator serving on the Judiciary Committee. This mailing, coupled with the College's other grassroots advocacy efforts, resulted in a substantial increase in the volume of calls to senators opposing the legislation.

The College also has a key congressional contact program. Members who volunteer to become "key contacts" for members of Congress receive special training on how to be an effective contact, as well as a monthly newsletter on legislative developments and regular legislative alerts. The College employs Jenn Jenkins as our full-time associate for grassroots advocacy to coordinate these services.

Finally, ACP-ASIM provides information to the governors in each state on what they can do to communicate the concerns of internists to their state's congressional delegation. Cathy Sullivan, our associate for state health policy, is the principal conduit of information on state and national legislation between the Washington Office and our Governors.

Even with support from ACP-ASIM, the challenge remains to convince internists that they are not powerless to influence national health policy. Too many of you still think that "it doesn't do any good" to spend your valuable time discussing issues with lawmakers and their staff members.

The fact is that each ACP-ASIM member who makes a call or sends a letter to a member of Congress is making a difference. Multiply that by hundreds or thousands of calls or letters from internists in every state and congressional district, and the result is an application of political power that no president or member of Congress can ignore.

Robert B. Doherty is ACP-ASIM's Vice President, Governmental Affairs and Public Policy.

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